Page 18 - Orthopedic Casts and Splints2

Performance Steps
b. Place the heel of the second hand on the dorsal aspect of the distal wrist.
c. Squeeze the heels of the hands together.
d. Apply firm and gradual pressure beginning at the wrist and progress up the forearm.
CAUTION: Excessive pressure may result in further patient injury. Talk to the patient while performing
this procedure ( e. g. How do you feel?, Is the pressure too much ? )
e. Maintain patient's wrist in correct position.
f. Remove heels of hands from the cast when contours of the wrist and forearm have been
shaped and the cast is cured.
NOTE: All casts require a mold. Crooked casts equal straight bones.
25. Mold the cast material to the bicipital muscle.
a. Place the palm of one hand on the anterior side of the biceps muscle.
b. Place the palm of the 2nd hand on the triceps muscle.
c. Press palms together and conform the plaster to the arm( hold for 5-30 seconds) or until
plaster/fiberglass begins to cure.
d. Have patient place injured arm on pillow to reduce arm strain.
26. Check range of motion ( ROM ) of phalanges and thumb.
a. Have patient extend, flex fingers and touch thumb to all fingers.
b. Cut the webril at the distal, proximal edges and at the base of the thumb.
CAUTION: The finished edge of the cast should end proximal to the base of the thumb to avoid radial
nerve impingement
c. Fold and tack down the webril and stockinette .

27. Check alignment of injured wrist with goniometer.
a. Place the stationary arm of the goniometer vertically, bisecting the forearm.
b. Place the moving arm of the goniometer vertically, bisecting the lateral side of the 5th
phalange(little finger).
c. Place protractor of the goniometer on the ulnar styloid.
d. The goniometer should measure 0-15 degrees of dorsal extension.
NOTE: If the wrist is not within 0-15 degrees of dorsal extension, ulnar or radial deviation are present,
remove cast and go to step 12.
28. Check alignment of injured elbow with goniometer.
a. Place the stationary arm of the goniometer ,bisecting the middle of the humerus and deltoid
muscle.
b. Place the moving arm of the goniometer bisecting the lateral aspect of the forearm and the
2nd and 3rd MCPJ's, forming a 90 degree angle.
c. Place the protractor of the goniometer on the olecranon process(elbow).
d. Set elbow until the goniometer measure 90 degrees of flexion.
29. Apply 3rd and 4th plaster/fiberglass roll( repeat steps19-20).

30. Trim the proximal and distal edges of cast.
a. Cut the outside edge of the webril.
b. Pull down the webril.
31. Check cast dimensions.
a. The distal edge of the cast rests at the DPC.
b. The radial aspect of the cast rests proximal to the snuff box .
c. Pull down the stockinette.
d. Trim as necessary.
e. Tape down edges of stockinette and webril

32. Apply 5th roll of plaster/fiberglass ( repeat step 19-20).
NOTE: The last roll in all casting applications is commonly referred to as the beautification roll or the
money roll. Take pride in your work.

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